Frühe postoperative Vollbelastung nach Sprunggelenksfrakturen Höde N, Ahrberg A, Josten C Fragestellung: Laut Leitlinien der DGU soll es nach einer operativ versorgten Sprunggelenksfraktur zur Frühmobilisation kommen. In Literatur und Lehrbüchern wird jedoch häufig eine p.o. Ruhigstellung im Gips oder Cast bis zu 6 Wochen empfohlen. Bei den eigenen Patienten erfolgt nach Versorgung einer Malleolarfraktur (AO 44 B oder C) ab dem 1. p.o. Tag eine schmerzorientierte Vollbelastung mit AirCast®-Schiene. Kommt es unter dieser frühen Vollbelastung zu einer erhöhten Komplikationsrate wie Materialversagen? Oder überwiegen die Vorteile durch das Vermeiden immobilisationsbedingter Komplikationen wie Thrombosen? Methodik Im Rahmen einer retrospektiven Studie wurden 82 Patienten (w:m = 47:35, 20-84 Jahre, Median 51 Jahre) eingeschlossen. Der Nachuntersuchungszeitraum betrug 5 - 68 Monate (Median 34,5 Monate). Nach der AO-Klassifikation lagen 46 (56,1%) B1-Frakturen, 15 (18,3%) B2-Frakturen, 12 (14,6%) B3-Frakturen und 9 (11%) C-Frakturen vor. Ausschlusskriterien waren Einschränkungen der aktiven Mobilisation durch Vorerkrankungen oder weitere Verletzungen sowie die Versorgung mit einer Stellschraube. Die Patienten wurden klinisch anhand des AOFAS-Scores nachuntersucht, es erfolgte eine radiologische Kontrolle und die Erfassung peri- und postoperativer Komplikationen wie Thrombosen, Infekte, Materialversagen und verzögerte Frakturheilung/Pseudarthrosen. Ergebnisse und Schlussfolgerung Der durchschnittliche Punktwert für den AOFAS Score beträgt für alle Patienten 89,38 Punkte (35-100, Median 98) und für den Score nach Olerud und Molander 85,24 Punkte (15-100, Median 95). Insgesamt traten neun (10,98%) Komplikationen auf: vier (4,88%) oberflächliche Wundheilungsstörung, vier Wundinfektionen (4,88%), darunter zwei Schraubenlockerungen (2,44%) und eine Redislokation nach erneutem Distorsionstrauma (1,22%). Weiteres Materialversagen oder Thrombosen traten nicht auf. Die frühe postoperative Vollbelastung führt nicht zu einer erhöhten Komplikationsrate, die beschriebenen Infekte sind mit der Vollbelastung zu assoziieren. Immobilisationsbedingte Komplikationen werden vermieden, der Patient kann schneller mobilisiert werden. Daher ist eine Ruhigstellung nach operativ versorgten Malleolarfrakturen nicht zu empfehlen.

Tiek kasdieninėje veikloje, tiek profesionaliame sporte patiriamos traumos tiesiogiai įtakoja žmogaus gyvenimo kokybę. Dažniausiai pasitaikantys apatinių galūnių lūžiai – kulkšnies srityje (Jensen, 1998): nuo 107 iki 184 šimtui tūkstančių žmonių per metus (Lin, 2006). Juos dažniausiai patiria 25–35 metų vyrai ir vyresnės nei 50 metų moterys (Staa, 2001). Gydant abiejų kulkšnių kaulų lūžius – atstatomi kaulų lūžgaliai, stiprinami pažeisti raumenys, sausgyslės ir raiščiai, taip pat mokoma taisyklingos eisenos bei laikysenos. Tyrimo metodika. Tyrimas atliktas VšĮ Kauno Raudonojo Kryžiaus klinikinėje ligoninėje 2006–2008 metais. Ištirta 30 asmenų – n=22 moterys (73,3 proc.) ir n=8 vyrų (26,7 proc.), kurių amžiaus vidurkis 47±5 metai, – po abiejų kulkšnių osteosintezės. Pacientai buvo suskirstyti į dvi grupes: tiriamąją ir kontrolinę. Tiriamajai grupei buvo taikyta kineziterapija su kineziterapeuto priežiūra, fizioterapija ir masažas, jiems gulint fizinės medicinos ir reabilitacijos skyriuje (24 dienas), o kontrolinė grupė buvo apmokyta ir atlikinėjo pratimus savarankiškai, namuose. Abiejų grupių tiriamieji buvo testuojami prieš pradedant taikyti kineziterapiją, po 12 dienų, po 24 dienų ir po 8 mėnesių. Tyrimo metu buvo atlikti matavimai: pėdos tiesimas, lenkimas, sukimas į vidų, sukimas į išorę, blauzdos apimtys (sveikos ir operuotos kojos), šlaunies apimtys (sveikos ir operuotos kojos), atliktas testavimas pagal Lysholm skalę, funkcinį pėdos ir kulkšnies testą. Skausmas... [toliau žr. visą tekstą] / Injuries sustained both in daily activity or in professional sports make direct influence on the quality of life of human being. Most often fractures of the lower limbs occur in the area of the ankle (Jensen, 1998): ankle fractures are found from 107 to 184 per one hundred thousand people annually. These fractures are most frequent among men of 25–35 years old and women over 50 years old (Staa, 2001). During the treatment of bimalleolar fractures of the ankle not only injured muscles, tendons and ligaments are fortified, fractures of bones are reconstituted but also the patients are taught how to keep good pace and posture. Methods. The analysis was performed at PI Kaunas Red Cross clinical hospital in 2006–2008. 30 persons were examined after bimalleolar osteosynthesis: n=22 women (73,3 percent.) and n=8 men (26,7 percent.), the average age being 47±5 years old. The patients were divided into two groups: research and control. Physiotherapy under the supervision of physiotherapist was applied to the research group together with massages while they were in the department of physical medicine and rehabilitation (for 24 days) as well. The control group participations were trained and instructed to performe the excercises at home, on their own. Patients of both groups were tested before the physiotherapy was applied, after 12 days, after 24 days and after 8 months. During the analysis the following measurements were taken: plantarflexion, dorsiflexion, inversion, eversion, shin... [to full text]

Anksčiau naudotiems čiurnos sąnario operacinio gydymo metodams (koreguojanti blauzdikaulio osteotomija, čiurnos sąnario artrodezė, artroplastika) atsirado alternatyva – čiurnos sąnario pakeitimas endoprotezu. Tačiau ir po pooperacinės reabilitacijos išlieka dalinis čiurnos sąnario funkcijos nepakankamumas, skausmo problema. Apie tai rašoma tiek užsienio tiek ir Lietuvos moksliniuose straipsniuose. Šio darbo tikslas nustatyti kineziterapijos programų efektyvumą po čiurnos sąnario pakeitimo operacijos Tyrimas buvo atliktas Palangos reabilitacijos ligoninėje. Tyrime dalyvavo pacientai po čiurnos sąnario pakeitimo. Visi pacientai buvo operuoti Klaipėdos ligoninėje sąnarių implantacijos centre (SIC), operacijas atliko tas pats ortopedas-traumatologas, visiems buvo implantuotas STAR tipo protezas. Pirmą grupę tiriamųjų sudarė 12 pacientų, visiems buvo taikyta pratimų terapija. Antrą grupę sudarė taip pat 12 pacientų, kuriems buvo atlikta pratimų terapija kartu su minkštųjų audinių atpalaidavimo metodika ir krioterapija. Matavimai buvo atliekami 2 kartus: atvykus į reabilitacijos ligoninę ir išvykstant. Buvo analizuojami bendri visų tiriamųjų rezultatai ir palyginti pirmosios ir antrosios grupių rezultatai. Nustatyta, kad po reabilitacinio gydymo statistiškai reikšmingai pagerėjo visi funkcinės būklės vertinimo rodikliai abiejose grupėse. Po gydymo čiurnos sąnario tiesimo ir lenkimo amplitudės padidėjo antrosios grupės tiriamiesiems. Antrosios grupės tiriamiesiems, taikant pratimų... [toliau žr. visą tekstą] / The surgical treatment methods of ankle joints (adjusting tibial osteotomy, arthrodesis of intertarsal joint, arthroplasty) were used before there appears an endoprosthesis for replacement of ankle joint. Even so, after the surgical rehabilitation there are still a partial insufficiency of ankle joint function and ache problems. Foreign and Lithuanian scientific press write about it equally. The purpose of this research work is to evaluate the physiotherapy influence on the rehabilitation efficiency. The second objective is to compare how the physiotherapy governed by relaxation techniques on soft issues and cryotherapy have had influence on the results. The research was done in Palanga rehabilitation hospital. The patients who have had the implanted ankle joint replacements were engaged in this research work. All patients had surgeries in Center for Joint Replacement (CJR) in Klaipeda hospital. It was done by the same orthopaedist-traumatologist. A STAR prosthesis were implanted into every patient. In first group there are 12 patients who have been applied physiotherapy. The second group consists of 12 patients as well who were treated by physiotherapy governed by relaxation techniques on soft tissues and cryotherapy. The measurements were done twice; arriving at rehabilitation hospital and leaving the hospital. The results of both groups have been studied and also they have been carefully compared. Conclusion. It is certain that after the rehab treatment the functional... [to full text]

Model-based radiostereometric analysis (MBRSA) of a total ankle arthroplasty (TAA) prosthesis was studied for the first time. The TAA MBRSA system precision was determined from the double exams of 20 patients implanted with the Mobility(TM). The MTE for any direction was 0.07mm for the tibial component. The MTE was 0.09mm and the MRE was 0.51° for the talar component. The MTPM detection limits were 0.22mm and 0.85mm for the tibial and talar components. Both components followed the typical subsidence-stabilization pattern. There was little detectable continuous migration at one to two years. The median(range) MTPM at two years was 0.96mm(0.17-2.28mm) and 1.23mm(0.39-1.9 mm) for the tibial and talar components. There was no detectable inducible displacement observed for any components at two years, except one talar component. The median(range) MTPM induced by the loading at two years was 0.08mm(0.03-0.18mm) and 0.39mm(0.27-1.06mm) for the tibial and talar components.

This study investigated the effects of hyperbaric oxygen (HBO) therapy on acute ankle injuries and determined if HBO therapy shortened time to recovery, decreased edema and pain, and increased range of motion and strength of the ankle. Subjects were randomly assigned to either an experimental (HBO) group (n = 4) or a control group (n = 4). All subjects received the same standardized physical therapy for lateral ankle sprains at the McGill Sport Medicine Clinic. The HBO group received 5 consecutive HBO treatments at 2.5 ATA for 90 minutes starting within 24 hours post injury. The control group received no HBO treatments. All subjects were evaluated by a physician within 24 hours of injury. All subjects suffered a second-degree lateral ankle sprain. Pain, range of motion, strength, volume displacement, and function were evaluated on the day of injury (Day 1), on Day 6 post injury, and on the day of return to play (Day RTP). There was no significant difference in time to return to play. However, the HBO group (25.5 +/- 11.6 days) did return 31% faster than the control group (36.8 +/- 19.4 days). There were no differences found between groups on the variables. There was a decrease in pain found over time (Day 1 was 57 mm, Day 6 was 18.5 mm, and Day RTP was 7 mm). The results of this study suggest that with treatment of HBO there is no effect on ankle sprains for return to play or improved function.

This study describes the biomechanics of the foot and ankle during the transitional and steady state skating strides using kinematic, kinetic, and myoelectric measures. A data set for five collegiate hockey players was completed (mean +/- SD: age = 21.8 +/- 1.9 years, height = 1.81 +/- 0.05 m, mass = 83.3 +/- 8.0 kg). Three acceleration strides and a constant velocity stride were examined on ice. An electrogoniometer at the ankle was used to measure angular displacement and velocity values. Myoelectric activation patterns were measured at the vastus medialis, tibialis anterior, peroneus longus, and medial gastrocnemius of the right lower limb. Kinetic pressure profiles were measured using piezo resistive fabric sensors providing accurate pressure measurement within the narrow confines of the skate boot-to-foot/ankle interface. Sixteen flexible piezo-resistive sensors (1.2 cm x 1.8 cm x 0.2 cm thick) were taped to discrete anatomical surfaces of the plantar, dorsal, medial and lateral surface of the foot, as well as to the posterior aspect of heel and leg. Repeated measures ANOVAs and Tukey post hoc tests found few significant differences among stride variables; however insights into the mechanics of ice hockey skating at the foot and ankle are given.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 81 leaves ; 30 cm / Damage to the proprioceptive organs, as well as lack of proprioceptive retraining, after an inversion ankle sprain, has been shown to contribute to the problem of recurring ankle joint injuries, which has the highest incidence of sports related injuries. The proprioceptive organs are important as afferent pathways in reflexes and for the adjustment of posture and muscle tone (Miller and Narson, 1995 and Jerosch and Bischof, 1996). Manipulation is thought to cause a change in the afferent pathways of the manipulated joints and it is proposed that this change may restore normal proprioceptive input, in a previously injured joint (Wyke, 1981 and Slosberg 1988). This however is unproven as indicated in a study by Lephart and Fu, (1995), where techniques to improve proprioception remain untested and according to Brynin and Farrar (1995), screening for proprioceptive and neuromuscular co-ordination should be carried out as part of a chiropractor’s physical examination and injury evaluation. This was a qualitative pre-post clinical study. Forty (40) subjects between the ages of 25 and 45, who had been diagnosed with chronic ankle instability syndrome, were recruited.

Thesis (M.Tech.: Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2005 221 leaves ; 30 cm / Previously the focus has been on the improvement of strength prior to proprioception (Calliet, 1997; Flemister et al. 1998 and Buhler et al. 2002). However according to Oloff (1994); Vegso (1995); Calliet (1997); Kawaguchi (1999); Buhler et al. (2002) and McGrew et al. (2003), focus should lie in obtaining a functional range of motion (increased flexibility) and proprioceptive ability and strength will follow with normalization of the relationship of the anatomical structures. All research in this regard has never assessed the assumption that the strength of the relevant musculature would return (Blokker et al.1992 and Klaue et al.1998). The objectives of this study were: to determine the relative effectiveness of Proprioceptive Neuromuscular Facilitation as compared to the Active Rocker-Board Exercises in the rehabilitation of chronic ankle sprains; as well as to determine the best sequence of applying these techniques to chronic ankle sprains in terms of objective clinical findings.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

The purpose was to determine the velocity during strength and power training, with elastic resistance bands, in older adults. Nine older patients, who attended the day hospital rehabilitation program at Riverview Health Centre, were trained for power and strength of the ankle muscles using elastic resistance bands for 4 to 6 weeks. Training sessions were filmed to assess the velocity of training using Proanalyst software. Power training occurred at faster peak velocities as compared to strength training (p<0.001) for both muscle groups, however there were significant differences for average velocity only during training of plantar flexors (p<0.001). There was no significant difference between strength and power training in terms of within individual variability. However, a wide variability was observed between subjects in velocities they trained at and overlap was found between velocities for strength and power training. Hence, researchers should monitor velocity during different types of training in older adults.